Genital cosmetic surgery for women, often referred to as Labiaplasty or vaginoplasty, has been quietly gaining popularity throughout the United States, as well as abroad. Although labia reduction, performed as a treatment for confirmed surgical conditions of the labia, has been used by surgeons for over half a century, its refinement into an aesthetic surgical procedure for female genitalia, which is now called Labiaplasty, has evolved most significantly during the past decade. This has resulted in the introduction of several new techniques for this procedure, published in the plastic surgical literature, and each touting certain advantages. The mainstream media has, likewise, picked up on this rising Labiaplasty popularity with sporadic superficial treatment of this topic in various articles and shows.
Why the Increased Interest in Labiaplasty?
To what factors can we attribute this increasing popularity of Labiaplasty? I’m unaware of any scientific or statistical studies exploring the varied reasons for which women seek Labiaplasty, but there is considerable anecdotal information that has been provided by patients.
I try to relate the increasing interest toward this surgery to the constantly changing social trends affecting women across the country, and I feel there are at least four areas that likely motivate this ever increasing number of women to decide upon undergoing a Labiaplasty. Let’s see if you don’t agree.
There are many women who experience the problem of physical pain and irritation of the labia minora, aggravated by efforts to participate in a physically active lifestyle. Once the sensitive and more fragile labia minora protrude beyond the protection of the more resilient labia majora, they are subject to greater contact with external forces. Whether it’s biking, horseback riding, “spinning” or simply the wearing of tight fitting clothing (e.g. designer jeans) or required sports attire (e.g. scuba gear), prolonged labial irritation, from recurring pressure and friction, discourages the participation in these activities by affected women. Those are but a few of the many examples of causes of labial discomfort frequently expressed by patients.
Another motivation for women to seek labiaplasty is the humiliation of having their labia unintentionally exposed to public view when wearing certain styles or fashions of clothing. Consider for example thong bathing suits or sheer panties. In many women with bodies which would otherwise be very suitable for such attire, the presence of protruding labia minora prevent them from even considering such revealing articles of clothing.
Next is the impact of “Brazilian Grooming” of a woman’s pubic region. With this current trend of shaving, waxing or laser hair removal, an absence of pubic hair means a clear visibility of labial detail, as well as any protrusion of the labia minora, beyond their naturally hidden location (within the confines of the labia majora). This gives meaning to what is now, at times, requested as the “Barbie Doll Look” by prospective Labiaplasty patients. Without the veil of an ample presence of pubic hair, many women are extremely embarrassed by the degree to which their labia minora are now plainly evident.
Finally, we must consider what exactly does fall into the realm of “normal” when referring to labial appearance. From a biologic or medical standpoint, labia minora as well as labia majora occur in a wide range of size and shape. All of this variation is quite normal, unless there is an underlying genetic or hormonal disorder. The fact that some women simply possess longer or shorter labia minora and even fatter or thinner labia majora, is not reason, in itself, for them to seek a surgical change. If these women are comfortable with the appearance of their genital area, a cosmetic Labiaplasty is unwarranted. However, there now exists a rapidly changing public perception of what’s normal and, hence, the appearance that some women seek is becoming more focused. This is brought about by the detailed scrutiny of other’s genital appearance, now possible through many media sources. Today, the naked human body is easily viewed in movies, magazines and websites, as well as during the sharing by young women of open shower and locker room facilities, providing little or no privacy. Through these “eye opening” experiences, women begin to acquire an altered impression of “normal” genital appearance, setting the stage for personal embarrassment, that naturally follows, if they feel their own appearance differs significantly from what they are seeing in others. This humiliation becomes the compelling reason for many women to consider Labiaplasty.
With these trends, as well as others, taking place, it comes as no surprise that Labiaplasty is becoming increasingly popular. The next obvious question is how this procedure is performed.
The Surgical Procedures
Although the terms Labiaplasty and Vaginoplasty are frequently used as a collective terms to mean several different cosmetic surgical procedures for the female genitalia, Labiaplasty is used most frequently to refer to surgical reduction of labia minora, when they protrude to an undesirable extent. Less commonly, plastic surgical alteration of the labia majora (labia majora reduction, liposuction or fat injection of the labia majora) is performed. Finally there are ancillary Labiaplasty procedures to alter either the exposure of the clitoris or its hood (clitoral hood reduction, clitoral hoodectomy or clitoropexy), which are occasionally performed in conjunction with Labiaplasty of the labia minora. To avoid confusion, I will use the simple term, Labiaplasty, hereinafter, to just imply cosmetic surgical reduction of the labia minora. I will refer to the other labial procedures by their more specific terms.
There are two basic techniques by which Labiaplasty is performed, and I will briefly describe each.
The first technique is that called the “trim” method of Labiaplasty which resembles the original labia reduction technique, used decades ago. This is a surgical amputation (removal) of the protruding portion of the labia minora. It was often performed in past years hurriedly and without much attention to detail. This, of course, produced the desired labial reduction, but not an aesthetically pleasing result. However, when performed by skilled surgeons adhering to current plastic surgical principles, and using “state of the art” surgical equipment and sutures, this is still a method that has some merit. In fact, its main disadvantage, in the viewpoint of some, is seen as a primary advantage in the opinion of others. Let me explain…
When performing the “trim” method, significant portions of the visible edges of a patient’s labia minora are surgically removed. This establishes new labial edges which, after complete healing, are pinker and smoother than the original, but which also must contain some scar tissue. For occasional patients, it is their natural labial edge appearance to which they mainly object. Their strongest wish is to be completely rid of the dark pigmentation within their labial edges, as well as elimination of the rugous appearance of their labia. Under this circumstance, only a “trim” method will offer the complete alteration in the “look” of their labia minora, that they are so vehemently requesting. This method of Labiaplasty is illustrated in the pre and post operative photographs of the following patient:
(Left: Before, Right: After)
(Left:Before, Right: After)
The second Labiaplasty technique is the “wedge” method, during which a “V” shaped portion of each labium is removed, and each labium is then carefully sutured back together, closing the “V”. This is done in such a manner that there’s scarcely a visible scar, and the labial edge retains a quite normal appearance, even after the labia minora protrusion has been dramatically corrected. In my experience, when patients are offered a choice between the two techniques, most prefer to undergo the “wedge” method and maintain their normal labial edge appearance. These photographs show a patient, illustrating the result to be expected from such a “wedge” Labiaplasty method:
(Left: Before, Right: After)
(Left: Before, Right: After)
Regarding the ancillary Labiaplasty procedures, the most common is clitoral hood reduction. This is designed to decrease the amount of protrusion of the clitoral hood, by surgically removing a strip of skin from each side of the hood, near its attachment. So easily is this procedure accomplished that, most often, it is performed simultaneously with the Labiaplasty. This decision should be made with the patient in advance of her surgery.
The procedure known as hoodectomy is a surgical removal of the portion of clitoral hood directly covering the clitoris. This procedure is performed with the intent of exposing more of the clitoris and, in theory, it permits greater clitoral sensitivity. The true functional benefit of this procedure, however, would be extremely difficult to test, and its potential value remains controversial. Nevertheless, hoodectomy is an easily accomplished procedure that can be performed simultaneously with Labiaplasty, or done as a separate procedure.
The last ancillary procedure to be mentioned is that of clitoropexy. This operation is designed to move the clitoris to a deeper location, so it protrudes less. This is accomplished by suturing the clitoris closer to the underlying pelvic bone. A clitoropexy is, technically, a somewhat more challenging procedure which should only be performed by surgeons well versed in that technique.
Strictly speaking, a Vaginoplasty is an operation during which the vagina is tightened by the surgical removal of excess vaginal lining and the “shoring up” of underlying muscles that have been torn or stretched (usually during childbirth). Because this operation causes no “visible” alteration in the appearance of the external female genitalia, it is not considered to be a cosmetic surgical procedure. To the contrary, Vaginoplasty is performed for purely functional reasons and, hence, is not an operation typically performed by plastic surgeons, myself included.
Illustrative Labiaplasty drawings and a currently up to date discussion can also be found here:
Cosmetic Surgery of the Labia Majora
Often overlooked in discussions about Labiaplasty, is the subject of surgery designed to improve or rejuvenate the appearance of the labia majora. As in the case of Labiaplasty (for the labia minora), such labia majora surgery has increased in popularity recently, presumably due to the impact of shaving or waxing the pubic area and genitalia, allowing the labial size and appearance to become much more evident. There are four prime conditions for which patients seem to seek this type of surgery.
The most frequent reason given by patients, as the source of their dissatisfaction with their labia majora, is the presence of a “deflated” and wrinkled labial skin surface. Though such is often a normal appearance, it tends to be interpreted as being the look of “older” women’s labia and, consequently, is very much unwanted. Surgical rejuvenation in this case requires some combination of skin tightening, with or without fat transfer into the labia (to “plump” them). The goal is always to achieve smooth skin, with or without a simultaneous increase in labia majora size, depending upon patient preferences. The skin tightening is accomplished by removing a strip of excess skin from the labia majora, such that the scar is hidden in the natural groove that exists between each labium majus and its adjacent labium minus. Following this skin tightening, if the labia still remain slightly wrinkled or appear undersized, injection of the patient’s own living fat (obtained by liposuction) is an effective way to augment labial volume and further smooth out the labial skin.
At other times, patients are troubled by their labia majora being too large. This creates the problem of a “bulge” existing in the crotch area, limiting their selection of suitable attire. As with lipodystrophy in other parts of the body, this can be effectively improved through liposuction (liposculpture).
In the case of patients who feel their labia majora appear simply too small, even though the skin may be smooth and unwrinkled, surgical intervention requires labial augmentation, again, preferably, by fat transfer.
Finally there is the occasional patient with labia majora asymmetry, one labium of a shape or size different from the other. Depending on which factor contributes to this asymmetry, one or more of the surgical techniques utilized in the previous conditions can be brought into play to help achieve better symmetry.
If you are a female reader, and this discussion of possibilities for cosmetic alteration of the labia majora happens to hit home, rest assured that these are all familiar and safe plastic surgical techniques. You no longer need to feel your condition has been overlooked (even though it is not well publicized) by the plastic surgical profession.
The Patient’s Experience
Unless it is performed for verifiable medical reasons, Labiaplasty is considered to be a form of cosmetic surgery. Classified as such, it’s usually not “covered” by health insurance companies. The cost of Labiaplasty can vary widely from one location to another, as well as from one surgeon to the next. Published prices seem to range from $2,000 to $10,000. It’s certainly smart for prospective patients to do some preliminary investigation and to “shop around” among a few highly regarded surgeons, if cost is going to be a factor.
Labiaplasty and the various ancillary procedures can all be performed on an outpatient basis, under twilight sleep (IV Sedation) or, if preferred, total sleep (General Anesthesia). The surgical time required for a Labiaplasty should generally range from 1 to 1 1/2 hours, if the operation is to be performed with meticulous attention, and patients should be wary of surgeons who claim to perform this procedure in significantly less time. Because of the outpatient nature of this surgery, as well as a relative paucity of proficient surgeons offering this procedure, it’s not uncommon for patients to decide to travel to a different city for their surgery. This may even entail a 2 – 3 day stay at their chosen location, particularly if they are traveling a significant distance, or traveling alone.
The recovery time (or down time from work or school) can vary from a couple days, with a well performed “wedge” Labiaplasty, to a week or more if the surgery is more extensive or if it hasn’t been meticulously done. Full healing, as with any surgery, requires 6 – 12 months.
When this surgery is properly performed, the complication rate should be very low. Post operative bleeding is common but usually minimal, and infection (by bacteria or yeast) should be infrequent, in spite of the inherently non-sterile nature of this area of the body. Significant loss of labial sensation should not be encountered. All sutures are dissolvable, and, on occasion, some may dissolve or become dislodged prematurely. This rarely presents a problem if a sufficient number of stitches were utilized. Sexual intercourse may be safely resumed after 6 weeks, without fear of disrupting the healing process.
It’s been my experience that most patients are exceedingly happy with their decision to go ahead with their labiaplasty and are elated by the inevitable boost to their self-esteem, which so many seem to experience. The satisfaction rate is extremely high, and the incidence of surgical revision is quite low.
For all types of surgery, there are good surgeons as well as some “not so good” surgeons. Labiaplasty surgery is no exception. There is an overlap of surgical specialties involved in the treatment of these patients, primarily involving Plastic Surgery and Gynecology. Prospective patients are strongly advised to seek out a Board Certified surgeon in one of those respective specialties. It is also important for prospective patients to be aware that not all plastic surgeons or all gynecologists regularly perform Labiaplasties, and some preliminary research in an effort to find a proficient surgeon, with appropriate experience as well as suitable credentials is important. Sub-specialization in the field of cosmetic genital surgery is also a favorable sign. This can often be detected in the literature or website information provided by the surgeon. Certainly, patients shouldn’t make the same mistake others have made, in requesting that a Labiaplasty be done, for the sake of convenience, while undergoing other surgery, without first being aware of their surgeon’s Labiaplasty expertise!
It’s now plainly evident that Labiaplasty is rapidly “coming of age”, chiefly driven by request of the female public. When performed under ideal circumstances and by proficient surgeons, this should be a safe and gratifying plastic surgical procedure. With the benefit of some advance knowledge and a thoughtful investigation, a good qualified surgeon should certainly be found. Years of humiliation can then be permanently put to rest, as the patient’s self-esteem is successfully restored.
About The Author
Charles Gruenwald, MD, FACS, is certified by the American Board of Plastic Surgery and has more than 30 years’ experience helping patients from the Louisiana market. His talent and experience are widely recognized, making him a highly sought after aesthetic surgeon. In addition to founding and maintaining an highly regarded practice in Baton Rouge, he served until recently as an Assistant Professor in Plastic Surgery at Louisiana State University, Department of Surgery. Attesting to his wide range of surgical experience, Dr. Gruenwald is also certified by the American Board of Otolaryngology.
Dr. Gruenwald is a 1969 graduate of Duke University School of Medicine. He completed a surgery internship and year of general surgery residency in New York City, at State University of New York, Kings County Hospital. Following this was completion of a three-year residency in otolaryngology at Harvard University Medical School, in Boston. He finished formal medical training in 1978, completing a two-year plastic surgery residency with the University of Utah College of Medicine, in Salt Lake City.
Dr. Gruenwald began his plastic surgery practice in 1978, when he helped establish “Associates in Plastic Surgery” in Baton Rouge, Louisiana. He has been one of the principal plastic surgeons for that group, ever since. For 25 years, of that time, he also was affiliated with LSU, as an associate professor in plastic surgery for the Division of Surgery, LSU School of Medicine.